Anthem Provider Newsletter – Missouri November 2022

This month’s featured articles

Administrative:

• CAA: Keep your provider directory information up to date
• Support documentation for AIM prior authorization requests

Digital Tools:

• Claims status message enhancements: providing clear descriptions and actionable next steps
• Submit digital attachments within seven-calendar days for claims filed with a PWK segment indicator
• You can now submit one electronic claim dispute for multiple claims and access correspondence digitally, too
• Visit the Provider Learning Hub to view our latest learning opportunities
• Remote EMR access service for HEDIS

Pharmacy:

• Specialty pharmacy updates – November 2022

Medical Policy & Clinical Guidelines:

• Medical policy and clinical guideline updates – November 2022
• Transition to AIM Specialty Health Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline

Reimbursement Policies:

• Outpatient Prepay Itemized Bill Review Program update – Facility
• New reimbursement policy: Place of Service – Facility

Medicare:

• Keep up with Medicare News – November 2022
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• Personalized Match

Click on the link for important information on FLUVENTION 2022.

FLUVENTION

HealthChoice Network News October 2022

In this issue

• CBC code removal
• Mammography
• Update to contract language
• Update to limitations
• Fee schedule updates
• Contact information

Cigna Network News 4th Quarter 2022

This quarter’s articles:

FEATURE ARTICLE

• com claim search enhancement

POLICY UPDATES

• Clinical, reimbursement, and administrative policy updates
• Precertification updates

ELECTRONIC TOOLS

• EFT enhancement: Enroll and manage on one screen
• Speed up common procedure code benefit lookups: New feature
• Message Center and claim status notifications coming soon
• Webinar schedule for digital solutions

NETWORK UPDATES

• New relationship with EyeMed for routine vision services
• Your care may be in-network under a strategic alliance plan
• Cigna + Oscar Health plans
• Cigna Gene Therapy Program updates

CLINICAL NEWS

• Tobacco cessation campaign

PHARMACY NEWS

• Changes in drug formulary effective January 1, 2023
• Home Infusion with Accredo
• Specialty Medical Injectables with Reimbursement Restriction

MEDICARE NEWS

• 2022 Cigna Medicare Advantage plan highlights
• Meet your Medicare Advantage Market Medical Executives
• Cigna Medicare Advantage COVID-19 updates
• Extending your treatment plan
• Single website coming for Cigna Medicare Advantage and commercial medical providers
• Bridging the Part D coverage gap

GENERAL NEWS

• Kaiser Permanente members to access Cigna PPO providers for emergency care
• 2023 Cigna Centers of Excellence displays
• Physician quality and cost-efficiency reconsideration requests
• Virtual Care Reimbursement Policy Oncology clinical consult service
• eviCore: Save time, submit precertification requests online
• Orthotics and prosthetics provider network to transition to eviCore
• Cigna Pathwell Specialty update: Ordering infusion services
• Diabetic retinal eye exam CPT II coding reminder
• Resources to support your care of Hispanic and Latino patients with diabetes
• Mitigating mental health stigma with culturally responsive care
• Updated LifeSOURCE provider reference guide
• Patient concerns or complaints

REGIONAL NEWS

• California provider directory update requirement
• California HMO provider appointment availability
• Adverse childhood experiences training for California providers
• California Language Assistance Program updated training Maryland nonparticipating specialists: Third-quarter notification

Please click the link for details regarding Mercy and Epworth Children & Family Services direct contract in place.

Epworth Direct to Employer memo UDPDATED 10-10-22

HOME STATE HEALTH PROVIDER NEWSLETTER

Home State Health – Connected in Care 2022 Newsletter

Welcome to Connected in Care from Home State Health, our newsletter developed specifically for providers with a focus on helping get the right care, in the right place, at the right time. Even as the prevalence of COVID-19 diminishes, we can still feel the effects of the pandemic on the healthcare system and on our world around us. Although we are slowly returning to a state of normalcy, there is still work to be done in assisting others to gain access to care.

In this issue, we will discuss the ways in which Home State Health, providers, care managers, and other healthcare professionals are working to close the care gaps in our system and provide better outcomes for everyone. We’ll also be looking at the importance of health equity in relation to HEDIS and the essential support that the Start Smart for Your Baby® program offers new and existing parents. Without your continued dedication, many would struggle to get the support they need. And for that, we thank you. We hope these resources help to continue closing the gaps in healthcare, and to better serve you in the fantastic work being done for our members.

Together, we are all connected in care.

Please click the link for details regarding Mercy and Epworth Children & Family Services direct contract in place.

Epworth Direct to Employer memo 10-10-22

Effective 12/01/2022 Healthy Blue will update its policy related to Anatomical Modifiers to align with CMS guidelines as well as national benchmarks and industry standards.

Please review the attachment for instructions and a list of the modifiers to be used.

Healthy Blue Anatomical Modifier Provider Communication

The Newsletter can be accessed by following the link below

Healthy Blue Medicaid October 2022 Newsletter

Included in this issue you’ll find information related to Monkeypox including symptoms, treatment, etc.

Details regarding the retraction of a policy entitles Sexually Transmitted Infections Testing – Professional.

Information and overview of a smoking cessation resource available to members.

Effective November 14, 2022, the direct agreement between Mercy and Integrity Home Care will terminate. On this date, their employees will move to a plan through Bayada accessing the Aetna provider network.

Please make sure that you request to see new identification cards when employees of this group present for care.